Cellulite Removal (Subcision and Fat Elevation)

What is Cellulite?

Cellulite refers to the dimpled or uneven skin texture commonly seen on the thighs, buttocks and hips. The skin surface may resemble an “orange peel” texture or contain visible depressions.

While cellulite is often associated with excess fat, it is primarily caused by structural changes beneath the skin. The appearance develops due to the interaction between:

• Fibrous connective tissue bands
• Fat pockets beneath the skin
• Skin elasticity and thickness

These uneven skin conditions can occur in individuals of all body types, including those who are slim or physically active.

Grades of Cellulite

The appearance of cellulite can vary from mild skin texture changes to deeper, more visible depressions. Clinically, cellulite is often described in grades based on its severity.

• Grade 1 (Mild) – the skin appears smooth while standing or lying down. Dimples may only become visible when the skin is pinched.
• Grade 2 (Moderate) – dimpling becomes visible while standing, but may disappear when lying down.
• Grade 3 (Severe) – depressions and uneven contours are visible in both standing and lying positions and the dimples may appear deeper.

How does Cellulite develop?

To understand cellulite, it is helpful to look at the structure of tissue beneath the skin. Under normal circumstances, the skin rests on a layer of fat that is supported by fibrous connective bands. These bands anchor the skin to deeper structures.

When cellulite develops:

• Fat pockets push upward, creating raised areas
• Fibrous bands pull the skin downward, forming dimples

This creates the characteristic “hills and valleys” seen on the skin surface. An easy way to visualise this is to imagine a mattress surface:

• The fat pockets form the raised portions
• The tightened fibrous bands create the indentations

As such, an effective treatment requires fat redistribution to smooth the contours after releasing the tethering bands.

Cellulite Removal with Subcision and Fat Elevation

Cellulite removal using subcision and fat elevation is a minimally invasive cellulite treatment designed to address the structural causes of cellulite beneath the skin. The procedure works by addressing two key elements responsible for cellulite, which are:

• Releasing the fibrous bands that pull the skin downward
• Elevating and smoothing the surrounding fat layer

By correcting both mechanisms simultaneously, the skin surface can appear smoother and more even.

• Subcision – this subcision step releases the bands, while fat elevation and fat redistribution smooth the underlying tissue. Using a specialised cannula inserted through a small incision, these tight bands are carefully separated. Once the tension is released, the skin is no longer pulled inward, allowing the depressed areas to lift. This step addresses the primary structural cause of cellulite dimpling.
• Fat Elevation – in addition to releasing the fibrous bands, the surrounding fat layer is gently elevated and redistributed. Fat pockets often contribute to the uneven contour of cellulite. Elevating the fat layer helps smooth the tissue beneath the skin, improving the overall surface appearance. A useful analogy is polishing plaster on a wall. After removing dents, the surface may still be uneven. Smoothing the plaster creates a more uniform finish. Similarly, fat elevation helps refine the contour after the tethering bands are released.

Why Subcision and Fat Elevation are performed together

Subcision and fat elevation are typically performed during the same procedure because they address complementary aspects of cellulite formation.

Releasing the fibrous bands alone may improve dimpling, but the surrounding fat layer may still appear uneven. Elevating the fat helps create a smoother transition beneath the skin.

By combining subcision and fat elevation, the procedure allows for precise fat redistribution and smoother skin contour.

How does the procedure work?

Cellulite subcision with fat elevation is performed through a small keyhole incision of approximately 5 mm. A specialised cannula is inserted beneath the skin to access the layer where cellulite forms.

The instrument allows our surgeon to:

• Break the fibrous tethering bands responsible for the dimples
• Elevate and smooth the surrounding fat layer

Once the connective bands are released and the fat layer is elevated, the treated area settles into a smoother contour beneath the skin. 

Benefits of Cellulite Removal with Subcision and Fat Elevation

This procedure offers several advantages for patients seeking to improve the appearance of cellulite.

Potential benefits include:

• Targets the structural cause of cellulite
• Releases the fibrous bands responsible for dimpling
• Smooths and redistributes the underlying fat layer
• Minimally invasive technique with small incisions
• Minimal visible scarring
• Potentially long-lasting improvement

Subcision and Fat Elevation vs Non-surgical Cellulite Treatments

A variety of non-surgical treatments are marketed for cellulite, including:

• Laser devices
• Radiofrequency treatments
• High-Intensity Focused Ultrasound (HIFU)
• Skin tightening technologies

These treatments typically work by heating tissue to stimulate collagen or tighten the skin. While this may improve skin firmness to some degree, they often do not directly release the fibrous bands that create cellulite dimples.

Since the structural tethering beneath the skin remains unchanged, the visible improvement may be limited or temporary for deeper cellulite depressions.

Subcision-based procedures, on the other hand, directly target the underlying connective bands responsible for the dimples, which is why they are often considered when a more significant correction is desired.

Why Dermal Fillers are not recommended for cellulite

Dermal fillers have occasionally been used to fill individual cellulite depressions. However, this approach does not address the structural causes of cellulite.

Potential limitations include:

• The fibrous bands that create the dimples remain intact
• Fillers provide temporary results that require repeat treatments
• Fillers may shift or disperse over time
• Multiple injections may be needed for larger areas

Because cellulite is primarily a structural condition beneath the skin, many surgeons prefer techniques that release the tethering bands rather than attempting to fill the depressions.

What to expect after the procedure

Cellulite subcision with fat elevation is generally performed as a minimally invasive procedure. After the treatment, patients may experience:

• Temporary swelling
• Mild bruising
• Tenderness in the treated areas

These effects are usually part of the normal healing process and gradually improve over time. Our surgeon will provide personalised instructions to support recovery and optimise the outcome.

Results and Aftercare

As healing progresses, the treated areas gradually settle and the skin contour may appear smoother. Results from cellulite removal with fat redistribution can be long-lasting, as the fibrous bands responsible for the dimples have been released.

However, factors that may influence long-term results include:

• Significant weight gain
• Natural changes in skin elasticity
• A small percentage of fibrous bands reform over time

Maintaining a stable weight and a healthy lifestyle can help preserve the results.

Surgical Approach to Cellulite Removal

Cellulite is often misunderstood as purely a fat-related condition. In reality, it involves complex structural changes beneath the skin, including fibrous connective bands and variations in fat distribution.

Effective treatment, therefore, requires a detailed understanding of the subcutaneous anatomy and the mechanisms that create the dimpling effect.

With experience in aesthetic surgical techniques, Dr Samuel Ho focuses on approaches that address the underlying structural causes of cellulite, rather than only the surface appearance. He uses innovative subcision techniques with fat elevation to achieve effective cellulite removal and smoother skin contours.

This structural approach aims to produce more meaningful and longer-lasting improvement in skin contour, particularly for patients with deeper cellulite depressions.

Book an Appointment

Cellulite can vary significantly in its cause, depth and severity. An in-person consultation allows for a careful assessment of the underlying structure contributing to the dimpling.

During the consultation, our surgeon can evaluate:

• The pattern and depth of the cellulite
• Whether fibrous tethering bands are present
• Which areas may benefit from subcision and fat elevation
• Whether alternative treatments may be more suitable

This discussion also provides an opportunity to understand the procedure, expected outcomes and recovery process. If you are considering cellulite treatment, scheduling a consultation can be a helpful first step in determining the most appropriate approach for your concerns.

Frequently Asked Questions